Normal and abnormal psychomotor development Katalin Hollody

Developmental milestones

Gross motor milestones mean age (months) Head up in prone position 1 Chest up in prone position 2 Up on elbows in prone position 3 Head control 3 Up on hands or wrists in prone position 4 Roll over prone to supine 4 Roll over supine to prone 5 Sit supported (tripod) 5 Creep 7 Get to sit 7 Crawl 8

Gross motor milestones mean age (months) Pull to standing 8 Cruise 10 Walk 12 Walk backward 14 Run 15

FINE MOTOR MILESTONES age (months) Fisted birth Unfisted 3 Reach and grab 4 Transfer 5 Rake from the surface 6 Immature pincer 9 Mature pincer 10 Voluntary release 12

INDICATIONS FOR REFERRAL FOR DELAYS AND DISORDERS OF LANGUAGE AND SPEECH Age Finding Birth and at any age Lack of response to sound Lack of interest in interaction with people 4 months Lack of any drive to communicate 6 to 9 months Loss of the early ability to coo or babble Poor sound localization or lack of responsiveness 12 months No verbal routines Failure to use ma-ma or da-da Loss of previous language or social milestones

INDICATIONS FOR REFERRAL FOR DELAYS AND DISORDERS OF LANGUAGE AND SPEECH Age Finding 15-18 mo No single words Poor understanding of language 24 mo Vocabulary less than 50 words No two-word phrases Less than 50% of speech intelligible to strangers 36 mo Rote memorization of words or phrases Frequent immediate or delayed repetition of others’ speech Flat or stilted intonation More than 75% of speech unintelligible to strangers

AUDIOLOGIC EVALUATION INDICATIONS FOR AUDIOLOGIC EVALUATION Family history of deafness Prematurity Perinatal complications Ototoxic drugs Congenital anomalies Intrauterine infection CNS infection Delayed speech or language development Parental concern about hearing loss

EYE EVALUATION SCREENING congenital intrauterine infection cerebral palsy strabismus nystagmus cornea problems cataracta prematurity

RISK FACTORS FOR COGNITIVE DEVELOPMENTAL DELAY 2-3 mo not alert to mother, with special interest 6-7 mo not searching for dropped object 8-9 mo not interest in peek-a-boo 12 mo does not search for hidden object 15-18 mo not interest in cause-and-effect games 2 y does not categorize similarities 3 y does not know own full name 4 y can not pick shorter or longer of two lines 4,5 y can not count sequentially 5 y does not know colors or any letters 5,5 y does not know own birthday or address

RISK FACTORS FOR PSYCOSOCIAL DEVELOPMENTAL DELAY 3 mo not smiling socially 6-8 mo not laughing in playful situation 1 yr hard to console, stiffens when approached 2 yr kicks, bites, screams easily and without provocation rocks back and forth in crib no eye contact or engagement with other children and adults 3-5 yr in constant motion resists discipline does not play with other children

SLEEP REQUIREMENTS IN CHILDREN

PREVALENCE OF DEVELOPMENTAL DISABILITIES

EVALUATION OF THE PATIENT History detailed family history search for other affected family members consanguinity prior gestational history (early postnatal death ?) pregnancy with the affected child timing, mode of delivery birth weight, head circumference, Apgar score duration of postnatal hospital stay timing of developmental milestones scholastic history coexisting medical problems (sz, feeding, sleeping, behavior)

PHYSICAL EXAMINATION Careful observation Dysmorphology Cutaneous markers Hepatosplenomegaly Height, weight Head circumference, shape, fontanels, sutures Focal neurological findings Vision, hearing

EXAMINATIONS Cytogenetic/molecular genetic examinations Metabolic work-up Imaging (UH, CT, MRI, SPECT, PET) Histology Evoked potentials EEG Tests (Bayley, Brunet-Lezine, Budapest-Binet)

IDENTIFICATION RATES OF DEVELOPMENTAL DISABILITIES Prevalence cases/1000 MD is first to make dg Mean age at identification (mo) Ment. retardation 25 76 39 Learning disab. 75 12 69 ADHD 150 44 59 CP 2-3 99 10 Visual disab. 0,3-0,6 87 55 Hearing disab. 0,8-2 64

CO-MORBIDITIES Behavior challenges     Psychiatric disorders      Seizures    Sensory impairments   Motor impairments      Sleep disorders      Recurrent vomiting      Autism

EVALUATION OF THE CHILD WITH GLOBAL DEVELOPMENTAL DELAY Obtain a detailed history and examination Refer for auditory and ophthalmologic screening Consider metabolic studies Obtain EEG, if history of seizures Consider screening for autism or a language disorder Is there a close family member with GDD? yes no Obtain specific tests for that disorder (cytogenetic screen, subtelomeric rearrangements) Are there features suggesting a specific dg? -genetic diagnosis (e.g. dysmorphic features)? specific test -CNS injury or malformation (aphyxia, seizures, CP)? MRI -environmental problems (lead exposure)? lead screen -loss or regression of dev. milestones? comprehensive evaluation: MRI, metabolic testing, EEG, cytogenetic screen

Multidisciplinary, comprehensive evaluation ! Consultation ! Multidisciplinary, comprehensive evaluation ! Second visit ! Early intervention ! Follow-up !